Provider Demographics
NPI:1972109304
Name:PEREZ MENDEZ, ROLANDO EMMANUEL (DC)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:EMMANUEL
Last Name:PEREZ MENDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 VICTORIA GARDENS BLVD APT 1204
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-8973
Mailing Address - Country:US
Mailing Address - Phone:787-383-8685
Mailing Address - Fax:
Practice Address - Street 1:1008 PARK AVENUE ORANGE PARK
Practice Address - Street 2:SUITE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-375-9429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor